Psychological therapy

Question 1

What are specific indications for CBT?

Answer 1

Depression
Generalised anxiety or panic disorder
Phobias
OCD
PTSD
Hypochondriasis
Bulimia

Question 2

Describe the process of CBT

Answer 2

C stands for ‘cognitive’ (what you think)
B stands for ‘behaviour’ (what you do)
T stands for ‘therapy’ (what you learn)

CBT helps breakdown overwhelming problems into smaller parts. This helps us see how they are connect and how they affect you (see pic)
* take history of nature of difficulties
* use assessment tools/questionnaires
* treatment plan formulated with clear goals and objectives.
* progress is monitored
* each session breaks difficulties into diffferent areas of thoughts, feelings and behvaiours - helps pt analuse these to determine their effect and consider change.
* pt expected to do homework between sessions by practicing changes in daily life.

Question 3

How long is a CBT program?

Answer 3

usually 20 sessions.
1 per week or fortnight
session lasts 30-60 mins

Question 4

What are different modalities of CBT?

Answer 4

individual therapy / 1:1
group CBT
self help with books
computerised CBT

Question 5

What is individaul psychodynamic psychotherapy based on (with regard to a person’s behaviour) ?

Answer 5

That behaviour is influenced by unconscious factors = thoughts, feelings, fantasies.

Question 6

What do we mean by psychological defences?

Answer 6

Just like our immune system protects our physical bodies, our psychological vulnerabilities are shielded by psychological defences. These defences can become overactive and lead to harm.

e.g. psychotic defences = delusional paranoia, denial
e.g immature defences = projection, schizoid fantasy, dissociation, acting out

Question 7

In psychodynamic psychotherapy, what is meant by transference and countertransference?

Answer 7

The past patterns (transfers) our present reactions to people. e.g if we trusted our parents, we are likely to trust friends, doctors, teachers.
These assumptions are brought forward. In turn, we have unconscious reactions to patients based on our past (countertransference)

Errors from this come about when we react to a pt like they were someone significant from our childhood (e.g. if your mum was an alcoholic, you may become too concerned with an alcoholic on the ward)
The reactions also affect patient feelings.

Question 8

What are the three key concepts in psychodynamic psychotherapy?

Answer 8

1. the unconscious
2. psychological defences
3. transference and countertransference

Question 9

What does a patinet need to have to be suitable for psychodynamic psychotherapy?

Answer 9

1. Psychological understandibility = can understand pt difficulties in psych terms
2. Psychological mindedness = pt can think about problems in psych terms
3. motivation = pt has motivation for insight and change
4. intelligence and verbal fluency = pt can communicate feelings ans thoughts with talking
5. introspectivenss = pt can reflect and think about feelings
6. dreams = pt has capacity to remember dreams
7. ego strength = pt can tolerate frustrating or distresssing feelings without impulsive behaviour
8. capacity to form relationships = need Hx of at least one sustained relationship in past or present.

Question 10

What are specific indications for psychodynamic psychotherapy?

Answer 10

• dissociative disorders
• depression
• psychosomatic disorders
• relationship problems
• grief

Question 11

Describe the technique of psychodynamic psychotherapy

Answer 11

• therapist provides secure frame = regular time and place and consistency
• pt narrates description about self and life
• therapist listens carefully and observes pts reactions of them
• therapist then offers linking hypotheses and interpretations that offer meaning
• previous inexplicable behaviour begins to make sense
• pt forms close relationship with therapist - based on empathy, genuineness and non-possessive warmth and sometimes challenge
• pt can work through difficulties safely

Question 12

When is psychodynamic psychotherapy not the right choice of therapy / who should you do PP with caution?

Answer 12

• pt w/ repeated admissions, repeated risk taking, insufficient ego-strength (can not tolerate frustrating feelings without acting out impulsively)
• hx of dropping out of relationships
• pts with acute psychosis
• severely depressed pt - may be too slow and unresponsive
• over sedated pts - can not access feelings
• pts who are actively misuing susbatnces and alcohol
• pts w/ no real motivation to change and unreal expectations of therapy

Question 13

What is family therapy?

Answer 13

evolving body of ideas and techniques focusing on a person’s difficulties within the context of people and culture that surrounds them

help family discuss problems that are straining their relationships

Question 14

what is systemic family therapy?

Answer 14

• focuses on family beliefs, patterns and meanings.
• works with a family’s strengths to help family members think about (and try) different ways of behaving with each other.

Question 15

What conditions can family therapy be used for?

Answer 15

Usually chronic illness
Can be used in schizophrenia, anorexia nervosa, and cystic fibrosis.

Question 16

What is the focus of CBT?

Answer 16

In the cognitive part:
Focus on thoughts and assumptons
Promotes that we respomd to our interpretation of events, no just what happened at events.

In the behavioural part:
Aim to alter behaviour, so if we change this, thoughts and emotions will evolve too

Question 17

What is the focus of psychodynamic therapies?

Answer 17

On the origin and meaning of symptoms, not just the presenting compliant. Based on a view that vulnerabilities come from early experiences and unresolved issues (usually from childhood)